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2. Association between immigration status and total knee arthroplasty outcomes in Ontario, Canada: a population-based matched cohort study

Author

Lex, Johnathan R., Pincus, Daniel, Paterson, J. Michael, Widdifield, Jessica, Chaudhry, Harman, Fowler, Rob, Hawker, Gillian, and Ravi, Bheeshma

Subjects
Quebec -- Health aspects -- Social aspects, Medical care -- Utilization, Refugees -- Health aspects, Immigrants -- Health aspects, Osteoarthritis -- Care and treatment -- Patient outcomes, Health, Health care industry
Abstract

Background: Immigrants and refugees face unique challenges navigating the health care system to manage severe arthritis, because of unfamiliarity, lack of awareness of surgical options, or access. The purpose of this study was to assess total knee arthroplasty (TKA) uptake, surgical outcomes, and hospital utilization among immigrants and refugees compared with Canadian-born patients. Methods: We included all adults undergoing primary TKA from January 2011 to December 2020 in Ontario. Cohorts were defined as Canadian-born or immigrants and refugees. We assessed change in yearly TKA utilization for trend. We compared differences in 1-year revision, infection rates, 30-day venous thromboembolism (VTE), presentation to emergency department, and hospital readmission between matched Canadian-born and immigrant and refugee groups. Results: We included 158 031 TKA procedures. A total of 11 973 (7.6%) patients were in the immigrant and refugee group, and 146 058 (92.4%) patients were in the Canadian-born group. The proportion of TKAs in Ontario performed among immigrants and refugees nearly doubled over the 10-year study period (p < 0.001). After matching, immigrants were at relatively lower risk of 1-year revision (0.9% v. 1.6%, p < 0.001), infection (p < 0.001), death (p = 0.004), and surgical complications (p < 0.001). No differences were observed in rates of 30-day VTE or length of hospital stay. Immigrants were more likely to be discharged to rehabilitation (p < 0.001) and less likely to present to the emergency department (p < 0.001) than Canadian-born patients. Conclusion: Compared with Canadian-born patients, immigrants and refugees have favourable surgical outcomes and similar rates of resource utilization after TKA. We observed an underutilization of these procedures in Ontario relative to their proportion of the population. This may reflect differences in perceptions of chronic pain or barriers accessing arthroplasty. Contexte : Les personnes immigrantes et r fugi es la recherche de soins pour une arthrite grave sont confront es des difficult s particuli res lorsqu'elles veulent s'y retrouver dans les m andres du syst me de sant , cause d'une m connaissance du syst me et des options th rapeutiques ou de probl mes d'acc s. Cette tude avait pour but d' valuer le recours l'arthroplastie pour proth se totale du genou (PTG), les r sultats chirurgicaux et le recours aux ressources hospitali res chez les personnes immigrantes et r fugi es comparativement aux malades n s au Canada. M thodes : Nous avons inclus tous les adultes soumis une intervention pour PTG primaire de janvier 2011 d cembre 2020 en Ontario. Les cohortes taient n es au Canada ou immigrantes et r fugi es. Nous avons valu les changements annuels du recours la PTG pour d gager une tendance. Nous avons compar les diff rences de taux de r vision 1 an et d'infection, de thromboembolie veineuse (TEV) 30 jours, les consultations aux services d'urgence, et les r admissions entre les groupes de patients n s au Canada et immigrants et r fugi s. R sultats : Nous avons inclus 158 031 cas de PTG. En tout, 11 973 (7,6%) appartenaient au groupe de personnes immigrantes et r fugi es, et 146 058 (92,4%), au groupe n au Canada. La proportion de PTG effectu es chez des personnes immigrantes et r fugi es en Ontario a presque doubl au cours de la p riode de 10 ans tudi e (p < 0,001). Apr s appariement, les personnes immigrantes taient expos es un risque relativement moindre de r vision 1 an (0,9% c. 1,6%, p < 0,001), d'infection (p < 0,001), de mortalit (p = 0,004), et de complications chirurgicales (p < 0,001). On n'a observ aucune diff rence quant au taux de TEV 30 jours ou quant la dur e du s jour hospitalier. Les personnes immigrantes taient plus susceptibles de recevoir leur cong pour aller en centre de r adaptation (p < 0,001) et moins susceptibles de consulter dans un service d'urgence (p < 0,001) que les personnes n es au Canada. Conclusion : Comparativement aux personnes n es au Canada, les personnes immigrantes et r fugi es obtiennent de bons r sultats chirurgicaux et des taux similaires d'utilisation des ressources apr s leur PTG. Nous avons observ une sous-utilisation de ces interventions par rapport leur proportion dans la population. Cela pourrait t moigner des diff rences de perception de la douleur chronique ou des probl mes d'acc s l'arthroplastie., Total knee arthroplasty (TKA) is a successful procedure performed more than 75 000 times a year in Canada. (1) Whereas the outcomes of this procedure are well documented, there has [...]

Published
2024
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8. Mortality, perioperative complications and surgical timelines in hip fracture patients: Comparison of the Spanish with the non-Spanish Cohort of the HIP ATTACK-1 trial

Author

Veevaete, Laurent, Waroux, Bernard le Polain de, Lavand'homme, Patricia, Cornu, Olivier, Tribak, Karim, Yombi, Jean C, Touil, Nassim, Bhutia, Jigme T, Clinckaert, Carol, Clippeleir, Dirk De, Reul, Maike, Patel, Ameen, Tandon, Vikas, Gauthier, Leslie P, Avram, Victoria R.A., Winemaker, Mitchell, de Beer, Justin, Simpson, Diane L, Worster, Andrew, Alvarado, Kim A, Gregus, Krysten K, Lawrence, Kelly H, Leong, Darryl P, Joseph, Philip G, Magloire, Patrick, Deheshi, Benjamin, Bisland, Stuart, Wood, Thomas J, Tushinski, Daniel M., Wilson, David A.J., Haider, Shariq, Bali, Kamal, Kearon, Clive, Manach, Yannick Le, Adili, Anthony, Tiboni, Maria E, Neary, John D, Cowan, David D, Khanna, Vickas, Zaki, Amna, Farrell, Janet C, MacDonald, Anne Marie, Conen, David, Wong, Steven C.W., Karbassi, Arsha, Wright, Douglas S, Shanthanna, Harsha, Coughlin, Ryan, Khan, Moin, Wikkerink, Spencer, Quraishi, Faraaz A, Lawendy, Abdel-Rahman, Kishta, Waleed, Schemitsch, Emil, Carey, Timothy, Macleod, Mark D, Sanders, David W, Vasarhelyi, Edward, Bartley, Debra, Dresser, George K, Tieszer, Christina, Jenkinson, Richard J, Shadowitz, Steven, Lee, Jacques S, Choi, Stephen, Kreder, Hans J, Nousiainen, Markku, Kunz, Monica R, Tuazon, Ravianne, Shrikumar, Mopina, Ravi, Bheeshma, Wasserstein, David, Stephen, David J.G., Nam, Diane, Henry, Patrick D.G., Wood, Gavin C.A., Mann, Stephen M., Jaeger, Melanie T., Sivilotti, Marco L.A., Smith, Christopher A., Frank, Christopher C., Grant, Heather, Ploeg, Leone, Yach, Jeff D., Harrison, Mark M., Campbell, Aaron R., Bicknell, Ryan T., Bardana, Davide D., Feibel, Robert J., McIlquham, Katie, Gallant, Catherine, Halman, Samantha, Thiruganasambandamoorth, Venkatesh, Ruggiero, Sara, Hadden, William J., Chen, Brian P.J., Coupal, Stephanie A., McMahon, Stephen J., McLean, Lisa M., Shirali, Hemant R., Haider, Syed Y., Smith, Crystal A., Watts, Evan, Santone, David J., Koo, Kevin, Yee, Allan J., Oyenubi, Ademilola N., Nauth, Aaron, Schemitsch, Emil H., Daniels, Timothy R., Ward, Sarah E., Hall, Jeremy A., Ahn, Henry, Whelan, Daniel B., Atrey, Amit, Khoshbin, Amir, Puskas, David, Droll, Kurt, Cullinan, Claude, Payendeh, Jubin, Lefrancois, Tina, Mozzon, Lise, Marion, Travis, Jacka, Michael J., Greene, James, Menon, Matthew, Stiegelmahr, Robert, Dillane, Derek, Irwin, Marleen, Beaupre, Lauren, Coles, Chad P., Trask, Kelly, MacDonald, Shelley, Trenholm, J.A.I., Oxner, William, Richardson, C.G., Dehghan, Niloofar, Sadoughi, Mehdi, Sharma, Achal, White, Neil J., Olivieri, Loretta, Hunt, Stephen B., Turgeon, Thomas R., Bohm, Eric R., Tran, Sarah, Giilck, Stephen M., Hupel, Tom, Guy, Pierre, O'Brien, Peter J., Duncan, Andrew W., Crawford, Gordon A., hou, Junlin, Zhao, Yanrui, Liu, Yang, Shan, Lei, Wu, Anshi, Muñoz, Juan M., Chaudier, Philippe, Douplat, Marion, Fessy, Michel Henri, Piriou, Vincent, Louboutin, Lucie, David, Jean Stephane, Friggeri, Arnaud, Beroud, Sebastien, Fayet, Jean Marie, Landais, Paul, Leung, Frankie Ka Li, Fang, Christian Xinshuo, Yee, Dennis King Hang, Sancheti, Parag K., Pradhan, Chetan V., Patil, Atul A., Puram, Chetan P., Borate, Madhav P., Kudrimoti, Kiran B., Adhye, Bharati A., Dongre, Himanshu V., John, Bobby, Abraham, Valsamma, Pandey, Ritesh A., Rajkumar, Arti, George, Preetha E., Sigamani, Alen, Stephen, Manesh, Chandran, Nitheesh, Ashraf, Mohammed, Georgekutty, A.M., Sulthan, Ahamad S., Adinarayanan, S., Sharma, Deep, Barnawal, Satish P., Swaminathan, Srinivasan, Bidkar, Prasanna U., Mishra, Sandeep K., Menon, Jagdish, M, Niranjan, Zk, Varghese, Hiremath, Santosh A., Nc, Madhusudhan, Jawali, Abhijit, Gnanadurai, Kingsly R., George, Carolin E., Maddipati, Atarao, Kp, Mary, Sharma, Vijay, Farooque, Kamran, Malhotra, Rajesh, Mittal, Samarth, Sawhney, Chavi, Gupta, Babita, Mathur, Purva, Gamangati, Shivanand, Tripathy, Vijaylaxmi, Menon, Prem H., Dhillon, Mandeep S., Chouhan, Devendra K., Patil, Sharanu, Narayan, Ravi, Lal, Purushotham, Bilchod, Prashanth N., Singh, Surya U., Gattu, Uttam V., Dashputra, Ravi P., Rahate, Prashant V., Turiel, Maurizio, Blasio, Giuseppe De, Accetta, Riccardo, Perazzo, Paolo, Stella, Daniele, Bonadies, Marika, Colombo, Chiara, Fozzato, Stefania, Pino, Fabio, Morelli, Ilaria, Colnaghi, Eleonora, Salini, Vincenzo, Denaro, Giuseppe, Beretta, Luigi, Placella, Giacomo, Giardina, Giuseppe, Binda, Mirko, Marcato, Anna, Guzzetti, Luca, Piccirillo, Fabio, Cecconi, Maurizio, Khor, H.M., Lai, Hou Yee, Kumar, C.S., Chee, K.H., Loh, P.S., Tan, Kit Mun, Singh, Simmrat, Foo, Li Lian, Prakasam, Komella, Chaw, Sook Hui, Lee, Meng-Li, Ngim, Joanne H.L., Boon, Huck Wee, Chin, Im Im, Kleinlugtenbelt, Ydo V., Landman, Ellie B.M., Flikweert, Elvira R., Roerdink, Herbert W., Brokelman, Roy B.G., Elskamp-Meijerman, Hannie F., Horst, Maarten R., Cobben, Jan-Hein M.G., Umer, Masood, Begum, Dilshad, Anjum, Anila, Hashmi, Pervaiz M., Ahmed, Tashfeen, Rashid, Haroon U., Khattak, Mujahid J., Rashid, Rizwan H., Lakdawala, Riaz H., Noordin, Shahryar, Juman, Naveed M., Khan, Robyna I., Riaz, Muhammad M., Bokhari, Syedah S., Almas, Ayesha, Wahab, Hussain, Ali, Arif, Khan, Hammad N., Khan, Eraj K., Nur, Aamer Nabi, Janjua, Kholood A., Orakzai, Sajjad H., Khan, Abdus S., Mustafa, Khawaja J., Sohail, Mian A., Umar, Muhammad, Khan, Siddra A., Ashraf, Muhammad, Khan, Muhammad K., Shiraz, Muhammad, Furgan, Ahmad, Ślęczka, Paweł, Dąbek, Piotr, Kumoń, Adam, Satora, Wojciech, Ambroży, Wojciech, Święch, Mariusz, Rycombel, Jacek, Grzelak, Adrian, Nowak- Kózka, Ilona, Gucwa, Jaroslaw, Machala, Waldemar, Ramokgopa, Mmampapatla T., Firth, Gregory B., Karera, Mwalimu, Fourtounas, Maria, Singh, Virsen, Biscardi, Anna, Iqbal, Muhammad N., Campbell, Ryan J., Maluleke, Matimba L., Moller, Carien, Nhlapo, Lerato, Maqungo, Sithombo, Flint, Margot, Nejthardt, Marcin B., Chetty, Sean, Naidoo, Rubendren, Guerra-Farfan, Ernesto, Tomas-Hernandez, Jordi, Garcia-Sanchez, Yaiza, Clua, Miriam Garrido, Molero-Garcia, Vicente, Minguell-Monyart, Joan, Teixidor-Serra, Jordi, Villar-Casares, Maria del Mar, Marsa, Jordi Selga, Porcel-Vazquez, Juan A., Andres-Peiro, Jose-Vicente, Aguilar, Marc, Mestre-Torres, Jaume, Colomina, Maria J., Guilabert, Patricia, Gozalo, M Luisa Paños, Abarca, Luis, Martin, Nuria, Usua, Gemma, Martinez-Ripol, Pedro, Posada, M.A. Gonzalez, Lalueza-Broto, Pilar, Sanchez-Raya, Judith, Camarena, Jorge Nuñez, Fraguas-Castany, Antoni, Balaguer-Castro, Mariano, Torner, Pere, Jornet-Gibert, Montsant, Serrano-Sanz, Jorge, Cámara-Cabrera, Jaume, Salomó-Domènech, Mònica, Yela-Verdú, Christian, Peig-Font, Anna, Ricol, Laura, Carreras-Castañer, Anna, Martínez-Sañudo, Luis, Herranz, Susana, Feijoo-Massó, Carlos, Sianes-Gallén, Mònica, Castillόn, Pablo, Bernaus, Martí, Quintas, Saioa, Gόmez, Olga, Salvador, Jordi, Abarca, Javier, Estrada, Cristina, Novellas, Marga, Torra, Mercè, Dealbert, Alfred, Macho, Oscar, Ivanov, Alexia, Valldosera, Esther, Arroyo, Marta, Pey, Borja, Yuste, Antoni, Mateo, Llorenç, Caso, Julio De, Anaya, Rafael, Higa-Sansone, J.L., Millan, Angelica, Baños, Victoria, Herrera-Mateo, Sergio, Aguado, Hector, Martinez-Municio, Gonzalo, León, Ricardo, Santiago-Maniega, Silvia, Zabalza, Ana, Labrador, Gregorio, Guerado, Enrique, Ramirez-Roldan, Alicia, Cruz, Encarnacion, Cano, Juan R, Bogallo, Jose M, Sangasoongsong, Paphon, Kulachote, Noratep, Sirisreetreerux, Norachart, Pengrung, Nachapan, Chalacheewa, Theerawat, Arnuntasupakul, Vanlapa, Yingchoncharoen, Teerapat, Naratreekoon, Bundit, Kadry, Miriam A, Thayaparan, Surendini, Abdlaziz, Ihab, Aframian, Arash, Imbuldeniya, Arjuna, Movahedi, Roya, Omran, Sherif, Vizcaychipi, Marcela P, Correia, Patricia, Patil, Shashank, Haire, Kevin, Mayor, Amy S.E., Dillingham, Sally, Nicholson, Laura, Elnaggar, Mohamed, John, Joby, Nanjayan, Shashi K, Parker, Martyn J, O'Sullivan, Susan, Marmor, Meir T, Matityahu, Amir, McClellan, Robert T, Comstock, Curt, Ding, Anthony, Toogood, Paul, Slobogean, Gerard, Joseph, Katherine, O'Toole, Robert, Sciadini, Marcus, Ryan, Scott P, Clark, Molly E, Cassidy, Charles, Balonov, Konstantin, Bergese, Sergio D, Phieffer, Laura S, Gonzalez-Zacarias, Alicia A, Marcantonio, Andrew J, Borges, Flavia K., Bhandari, Mohit, Nuñez, Jorge H., Castillon, Pablo, De Caso Rodriguez, Julio, Aguado, Hector J., Popova, Ekaterine, Tonelli, Ana Claudia, Balasubramanian, Kumar, Vincent, Jessica, Harvey, Valerie, Kocaqi, Etri, and Devereaux, P.J.

Published
2024
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9. Superstition in Surgery: A Population-Based Cohort Study to Assess the Association Between Surgery on Friday the 13th and Postoperative Outcomes

Author

Ranganathan, Sanjana, Riveros, Carlos, Geng, Michael, Chang, Courtney, Tsugawa, Yusuke, Ravi, Bheeshma, Melchiode, Zachary, Hu, Siqi, Kobashi, Kathleen, Miles, Brian J., Klaassen, Zachary, Nathens, Avery, Coburn, Natalie, Detsky, Allan S., Jerath, Angela, Wallis, Christopher J. D., and Satkunasivam, Raj

Published
2024
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13. Association Between Periprosthetic Joint Infection and Mortality Following Primary Total Hip Arthroplasty.

Author

Mundi, Raman, Pincus, Daniel, Schemitsch, Emil, Ekhtiari, Seper, Paterson, J. Michael, Chaudhry, Harman, Leis, Jerome A., Redelmeier, Donald A., and Ravi, Bheeshma

Subjects
PROSTHESIS-related infections, TOTAL hip replacement, MORTALITY, DEATH rate
Abstract

Background: Periprosthetic joint infection (PJI) remains a dreaded and unpredictable complication after total hip arthroplasty (THA). In addition to causing substantial morbidity, PJI may contribute to long-term mortality risk. Our objective was to determine the long-term mortality risk associated with PJI following THA. Methods: This population-based, retrospective cohort study included adult patients (‡18 years old) in Ontario, Canada, who underwent their first primary elective THA for arthritis between April 1, 2002, and March 31, 2021. The primary outcome was death within 10 years after the index THA. Mortality was compared between propensity-score-matched groups (PJI within 1 year after surgery versus no PJI within 1 year after surgery) with use of survival analyses. Patients who died within 1 year after surgery were excluded to avoid immortal time bias. Results: A total of 175,432 patients (95,883 [54.7%] women) with a mean age (and standard deviation) of 67 ± 11.4 years underwent primary THA during the study period. Of these, 868 patients (0.49%) underwent surgery for a PJI of the replaced joint within 1 year after the index procedure. After matching, patients with a PJI within the first year had a significantly higher 10-year mortality rate than their counterparts (11.4% [94 of 827 patients] versus 2.2% [18 of 827 patients]; absolute risk difference, 9.19% [95% confidence interval (CI), 6.81% to 11.6%]; hazard ratio, 5.49 [95% CI, 3.32 to 9.09]). Conclusions: PJI within 1 year after surgery is associated with over a fivefold increased risk of mortality within 10 years. The findings of this study underscore the importance of prioritizing efforts related to the prevention, diagnosis, and treatment of PJIs. [ABSTRACT FROM AUTHOR]

Published
2024
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15. Relationship Between Patient‐Reported Readiness for Total Knee Arthroplasty and Likelihood of a Good Outcome at One‐Year Follow‐Up

Author

Hawker, Gillian A., Conner‐Spady, Barbara L., Bohm, Eric, Dunbar, Michael J., Jones, C. Allyson, Ravi, Bheeshma, Noseworthy, Tom, Woodhouse, Linda J., Faris, Peter, Dick, Donald, Powell, James, Paul, Paulose, Marshall, Deborah A., Hawker, Gillian A., Marshall, Deborah A., Bohm, Eric, Dunbar, Michael J., Faris, Peter, Jones, C. Allyson, Noseworthy, Tom, Ravi, Bheeshma, and Woodhouse, Linda

Published
2022
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30. Variation in care for patients presenting with hip fracture in six high‐income countries: A cross‐sectional cohort study.

Author

Burrack, Nitzan, Hatfield, Laura A., Bakx, Pieter, Banerjee, Amitava, Chen, Yu‐Chin, Fu, Christina, Godoy Junior, Carlos, Gordon, Michal, Heine, Renaud, Huang, Nicole, Ko, Dennis T., Lix, Lisa M., Novack, Victor, Pasea, Laura, Qiu, Feng, Stukel, Therese A., Uyl‐de Groot, Carin, Ravi, Bheeshma, Al‐Azazi, Saeed, and Weinreb, Gabe

Subjects
INTERNAL fixation in fractures, LENGTH of stay in hospitals, DEVELOPED countries, TOTAL hip replacement, CROSS-sectional method, HIP fractures, RETROSPECTIVE studies, ACQUISITION of data, HEMIARTHROPLASTY, PATIENT readmissions, COMPARATIVE studies, OSTEOPOROSIS, MEDICAL records, HOSPITAL care, DESCRIPTIVE statistics, RESEARCH funding, PATIENT care, LONGEVITY, LONGITUDINAL method, OLD age
Abstract

Background: Hip fractures are costly and common in older adults, but there is limited understanding of how treatment patterns and outcomes might differ between countries. Methods: We performed a retrospective serial cross‐sectional cohort study of adults aged ≥66 years hospitalized with hip fracture between 2011 and 2018 in the US, Canada, England, the Netherlands, Taiwan, and Israel using population‐representative administrative data. We examined mortality, hip fracture treatment approaches (total hip arthroplasty [THA], hemiarthroplasty [HA], internal fixation [IF], and nonoperative), and health system performance measures, including hospital length of stay (LOS), 30‐day readmission rates, and time‐to‐surgery. Results: The total number of hip fracture admissions between 2011 and 2018 ranged from 23,941 in Israel to 1,219,696 in the US. In 2018, 30‐day mortality varied from 3% (16% at 1 year) in Taiwan to 10% (27%) in the Netherlands. With regards to processes of care, the proportion of hip fractures treated with HA (range 23%–45%) and THA (0.2%–10%) differed widely across countries. For example, in 2018, THA was used to treat approximately 9% of patients in England and Israel but less than 1% in Taiwan. Overall, IF was the most common surgery performed in all countries (40%–60% of patients). IF was used in approximately 60% of patients in the US and Israel, but only 40% in England. In 2018, rates of nonoperative management ranged from 5% of patients in Taiwan to nearly 10% in England. Mean hospital LOS in 2018 ranged from 6.4 days (US) to 18.7 days (England). The 30‐day readmission rate in 2018 ranged from 8% (in Canada and the Netherlands) to nearly 18% in England. The mean days to surgery in 2018 ranged from 0.5 days (Israel) to 1.6 days (Canada). Conclusions: We observed substantial between‐country variation in mortality, surgical approaches, and health system performance measures. These findings underscore the need for further research to inform evidence‐based surgical approaches. [ABSTRACT FROM AUTHOR]

Published
2023
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37. Sex-specific differences in 30-day outcomes following primary total hip replacement in 86,684 patients.

Author

Chaudhry, Harman, Ekhtiari, Seper, Ravi, Bheeshma, Wadey, Veronica, Tomescu, Sebastian, Murnaghan, John, and Mundi, Raman

Subjects
OPERATING rooms, TOTAL hip replacement, CONFIDENCE intervals, MULTIVARIATE analysis, MULTIPLE regression analysis, MORBID obesity, SURGICAL complications, SEX distribution, COMPARATIVE studies, QUALITY of life, REOPERATION, SURGICAL site infections, ODDS ratio, LONGITUDINAL method, DISEASE risk factors, DISEASE complications
Abstract

Introduction: Although differential outcomes based on sex are widespread in medicine and surgery, evaluation of sex-specific differences in the field of orthopaedic surgery in general – and arthroplasty in particular – are lacking. We hypothesised that morbidly obese male and female patients would have differing risks of surgical complications following primary total hip replacement. Methods: We reviewed data contained within the American College of Surgeons National Quality Improvement Program (ACS-NSQIP) database from 2015 through 2018, inclusive. A multivariable binary logistic regression model was used to determine the adjusted odds ratios (OR) of relevant variables on primary and secondary outcomes. Results: A total of 86,684 patients undergoing THR were identified, of whom 9972 patients (4095 male and 5877 female) were morbidly obese. Among morbidly obese patients, odds of surgical site infection were higher in females than males within 30 days of surgery (adjusted OR 1.40; 95% CI, 1.10–1.79; p = 0.007). This comprised the odds of both superficial infection (1.8% vs. 1.1%, adjusted OR 1.67; 95% CI, 1.16–2.40; p = 0.006) and deep infection (1.9% vs. 1.4%, adjusted OR 1.22; 95% CI, 0.88–1.68; p = 0.24). Unexpected return to the operating room (i.e., reoperation) within 30 days of the surgical procedure was also higher among females than males (4.2% vs. 3.1%, adjusted OR 1.38, 95% CI, 1.10–1.71, p = 0.005). There were no differences between male and female patients in the non-obese cohort. Conclusions: Among patients with morbid obesity, the risk of surgical site infection and reoperation within the first 30 days is greater in women as compared to men. Future research must address whether this early increased risk among morbidly obese women persists in the longer term, and whether it results in compromised function or quality of life. [ABSTRACT FROM AUTHOR]

Published
2023
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38. Reporting and evaluating wait times for urgent surgery for hip fracture in Ontario, Canada

Author

Pincus, Daniel, Wasserstein, David, Ravi, Bheeshma, Byrne, James P., Huang, Anjie, Paterson, J. Michael, Nathens, Avery B., Kreder, Hans J., Jenkinson, Richard, and Wodchis, Walter P.

Subjects
Hip fracture repair -- Statistics, Hospital waiting lists -- Evaluation, Health
Abstract

BACKGROUND: Although a delay of 24 hours for hip fracture repair is associated with medical complications and costs, it is unknown how long patients wait for surgery for hip fracture. We describe novel methods for measuring exact urgent and emergent surgical wait times (in hours) and the factors that influence them. METHODS: Adults aged 45 years and older who underwent surgery for hip fracture (the most common urgently performed procedure) in Ontario, Canada, between 2009 and 2014 were eligible. Validated data from linked health administrative databases were used. The primary outcome was the time elapsed from hospital arrival recorded in the National Ambulatory Care Reporting System until the time of surgery recorded in the Discharge Abstract Database (in hours). The influence of patient, physician and hospital factors on wait times was investigated using 3-level, hierarchical linear regression models. RESULTS: Among 42 230 patients with hip fracture, the mean (SD) wait time for surgery was 38.76 (28.84) hours, and 14174 (33.5%) patients underwent surgery within 24 hours. Variables strongly associated with delay included time for hospital transfer (adjusted increase of 26.23 h, 95% CI 25.38 to 27.01) and time for preoperative echocardiography (adjusted increase of 18.56 h, 95% CI 17.73 to 19.38). More than half of the hospitals (37 of 72, 51.4%), compared with 4.8% of surgeons and 0.2% of anesthesiologists, showed significant differences in the risk-adjusted likelihood of delayed surgery. INTERPRETATION: Exact wait times for urgent and emergent surgery can be measured using Canada's administrative data. Only one-third of patients received surgery within the safe time frame (24 h). Wait times varied according to hospital and physician factors; however, hospital factors had a larger impact., Hip fracture repair that is delayed more than 24 hours after hospital presentation is associated with increased medical complications (1) and health care costs. (2,3) Despite known consequences for delays, [...]

Published
2018
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50. Association of age, sex and race with prescription of anti-osteoporosis medications following low-energy hip fracture in a retrospective registry cohort.

Author

Hoit, Graeme, Whelan, Daniel B., Atrey, Amit, Ravi, Bheeshma, Ryan, Gareth, Bogoch, Earl, Davis, Aileen M., and Khoshbin, Amir

Subjects
HIP fractures, RACE, SECONDARY prevention, HEALTH equity, MINORITIES, OLDER patients
Abstract

Background: Initiation of anti-osteoporosis medications after hip fracture lowers the risk of subsequent fragility fractures. Historical biases of targeting secondary fracture prevention towards certain groups may result in treatment disparities. We examined associations of patient age, sex and race with anti-osteoporosis medication prescription following hip fracture. Methods: A cohort of patients with a hip fracture between 2016–2018 was assembled from the American College of Surgeons National Surgical Quality Improvement Program registry. Patients on anti-osteoporosis medications prior to admission were excluded. Multivariable logistic regression was used to determine adjusted associations between patient age, sex and race and their interactions with prescription of anti-osteoporosis medications within 30 days of surgery. Results: In total, 12,249 patients with a hip fracture were identified with a median age of 82 years (IQR: 73–87), and 67% were female (n = 8,218). Thirty days postoperatively, 26% (n = 3146) of patients had been prescribed anti-osteoporosis medication. A significant interaction between age and sex with medication prescription was observed (p = 0.04). Male patients in their 50s (OR:0.75, 95%CI:0.60–0.92), 60s (OR:0.81, 95%CI:0.70–0.94) and 70s (OR:0.89, 95%CI:0.81–0.97) were less likely to be prescribed anti-osteoporosis medication compared to female patients of the same age. Patients who belonged to minority racial groups were not less likely to receive anti-osteoporosis medications than patients of white race. Interpretation: Only 26% of patients were prescribed anti-osteoporosis medications following hip fracture, despite consensus guidelines urging early initiation of secondary prevention treatments. Given that prescription varied by age and sex, strategies to prevent disparities in secondary fracture prevention are warranted. [ABSTRACT FROM AUTHOR]

Published
2022
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